Hospital staff should be disciplined if they are caught smoking, according to harsh new guidance from health authorities.
The National Institute for Health and Care Excellence (Nice) guidance demanded the scrapping of smoking shelters outside hospitals so visitors and staff are both prevented from lighting up.
"It has been tolerated by the NHS and it is high time that stopped," Nice public health director Mike Kelly said.
"We need to end the terrible spectacle of people on drips in hospital gowns smoking outside hospital entrances."
The guidance, which was branded draconian by smokers' groups, demanded staff should stop helping patients get out of bed if they are going to smoke and instead offer brief advice on quitting and referral to assistance.
Smokers in hospitals should be targeted with help to quit, it suggested.
The plan would hit psychiatric wards particularly hard, where 70% of people smoke.
"NHS staff have a duty of care to protect people's health, but that doesn't include the right to nag, cajole or bully smokers to quit," Simon Clark, of smokers' lobby group Forest, said.
"Tobacco is a legal product and a lot of people smoke to relieve stress.
"It's not only heartless and inhumane to ban patients from smoking outside hospitals and clinics, it's almost impossible to enforce without installing CCTV cameras and employing wardens to monitor the grounds."
Many hospitals have already implemented similar proposals, but the Nice guidance is intended to create a consistent nationwide programme.